Consent and anaesthetic risk

Jenkins, Kath

doi:10.1093/med/9780198719410.003.0002_update_001

Cited by 4 publications

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“…35,36 Aspiration of gastric contents after regurgitation during intubation is an uncommon complication of anesthesia, occurring in 1 of 2000 patients. 37 In obesity, the risk of aspiration is increased due to the increased intra-abdominal pressure. 12,36 However, across 3 studies, there was only one event, involving in a patient using FM preoxygenation.…”

Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula for Apneic Oxygenation in Obese Patients for Elective Surgery: A Systematic Review and Meta-Analysis

Bright

Harley

Velli

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Obese patients desaturate rapidly during the apneic period after induction of anesthesia for elective surgery. Administration of oxygen using high-flow nasal cannulae (HFNCs) may prevent desaturation in nonobese patients compared to facemask (FM) preoxygenation. The aim of this meta-analysis was to compare the effectiveness of HFNC to FM preoxygenation techniques in reducing preintubation desaturation in obese patients undergoing elective surgery. METHODS: This study protocol was registered on PROSPERO (CRD42022309391). Adult studies that compared HFNC and FM preoxygenation in obese patients requiring general anesthesia for elective surgery were included. The primary outcome was desaturation resulting in oxygen saturation of <92% from induction of anesthesia until intubation. Secondary outcomes included the lowest arterial oxygen content before intubation expressed in mm Hg, safe apnea time expressed in seconds, the lowest oxygen saturation before intubation expressed as a percentage, patient-reported discomfort, the need for rescue ventilation, and the incidence of aspiration of gastric contents during intubation. Risk of bias was assessed using the Cochrane Collaboration tool. Certainty was assessed following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS: Six studies including 351 participants were eligible for analysis. There was no difference in odds of oxygen desaturation <92% between HFNC and FM (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.15-1.63; P = .24). The HFNC group had a significantly longer safe apnea time (mean difference [MD], -124.20 with 95% CI, -200.47 to −47.93; P = .001). There was no difference between HFNC and FM in the lowest arterial oxygen content (MD, −23.90; 95% CI, −88.64 to 40.85; P = .47) and the lowest peripheral oxygenation saturation (MD, −0.47 with 95% CI, -5.07 to 4.12; P = .84). HFNC had a lower odd of discomfort than FM (OR, 0.13; 95% CI, 0.03-0.52; P = .004). There was no difference in the odds of aspiration of gastric contents between HFNC and FM (OR, 0.33; 95% CI, 0.01-8.21; P = .50). The risk of bias for our primary and secondary outcomes was low. The GRADE assessment for our primary outcome indicated a low level of certainty. For secondary outcomes, the GRADE assessment indicated a very low certainty for all outcomes except for patient discomfort, which was indicated as a moderate level of certainty. CONCLUSIONS: There may be no difference between HFNC and FM preoxygenation in preventing oxygen desaturation <92% or the lowest oxygen saturation before intubation. Preparation remains important to prevent and manage desaturation during induction of obese patients.

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Section: Discussionmentioning

confidence: 99%

High-Flow Nasal Cannula for Apneic Oxygenation in Obese Patients for Elective Surgery: A Systematic Review and Meta-Analysis

Bright

Harley

Velli

et al. 2022

Anesthesia &Amp; Analgesia

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“…At present our hospital lead to carry out hip dislocation in children with orthopedic surgery, some of them over the age of three years children underwent pelvic osteotomy. This surgical trauma, postoperative pain in children with a strong stress response, leading to increased secretion of endogenous catecholamines, is not conducive to the recovery of children with physiological function.The frequency of anesthesia related symptoms during the first 24 hours following surgery is as follows: [4] i) Vomiting -10-20% ii) Nausea -10-40% iii) Sore throat -25% iv) Incisional pain -30%…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Different Doses of Sufentanil Combined With Flurbiprofen Axetil In Postoperative Analgesia for Children Undergoing Innominate Osteotomy in China

Chowdhury

Barua²,

Das

et al. 2017

J Chittagong Med Coll Teachers Ass

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To evaluate the analgesic efficacy of different doses of sufentanil combined with flurbiprofen axetil in children undergoing innominate osteotomy. Ninety children scheduled for elective innominate osteotomy under general anesthesia were enrolled and randomly divided into 3 groups. All the children received 1mg/kg flurbiprofen axetil intravenously before skin incision for pre-emptive analgesia. Patient Controlled Intravenous Analgesia (PCIA) was started at the end of the operation with the following composition: Sufentanil 1.5 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml (Group N1) sufentanil 2.0 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml (Group N2) and sufentanil 2.5 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml (Group N3). FLACC scores and Ramsay sedation scores were recorded at 2, 4 ,8 ,12 ,24 and 36h after the operation;the PCA button press number and side effects were observed and recorded. FLACC scores in group N1 were higher than group N2 and N3 (p<0.05).Ramsay scores in group N1 were lower than group N2 and N3 (p<0.05).There were no significant differences in FLACC scores and Ramsay scores between group N1 and N2 (p> 0.05).The incidence of side effects was significantly higher in group N3 compared with group N1 and N2 (p<0.05). Combined with 1mg/kg flurbiprofen axetil for preemptive analgesia , PCIA with sufentanil 2.0 g/kg and ondansetron 0.1 mg/kg in 0.9% NS 100ml may be an effective postoperative analgesia solution for children undergoing innominate osteotomy ,with less side effects. JCMCTA 2016 ; 27 (2) : 77 - 80

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“…General anaesthesia is associated with risk of complications such as sore throat, nausea and vomiting, respiratory infection, anaphylaxis, peripheral nerve damage and death. Although death is extremely rare (1 in 100,000 general anaesthetics), negating this risk is attractive. The cost of a non‐elective inpatient short and long stay combined (excluding excess bed days) is £1,489 when averaged across NHS trusts .…”

Section: Introductionmentioning

confidence: 99%

Extra‐oral drainage of submandibular abscess under local anaesthetic: review of the literature and case series

et al. 2016

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Background Extra‐oral drainage of odontogenic abscesses is commonly performed by oral and maxillofacial surgeons. It is a potentially hazardous and expensive procedure, but in selected cases can be carried out under local anaesthetic, avoiding some of the risks and costs associated with general anaesthesia. Aim To evaluate the management options for odontogenic abscesses. Method A review of the literature with respect to radiological, anaesthetic and surgical techniques that facilitate extra‐oral incision and drainage under local anaesthetic. Results A case series demonstrates the value of imaging, the Vazirani–Akinosi mandibular nerve block, a specific forcep technique and local anaesthetic extra‐oral drainage of the submandibular space. Conclusions Oral surgeons can utilise their specialist knowledge of head and neck anatomy, local anaesthetic technique, surgical skills and specialist equipment to deliver quick and definitive treatment for odontogenic abscesses. To our knowledge, extra‐oral incision and drainage of dental abscesses is not regularly carried out under local anaesthetic. However, if removal of the causative tooth and abscess drainage can be undertaken under local anaesthetic, the risks and costs of general anaesthesia can be avoided.

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Consent and anaesthetic risk

Cited by 4 publications

References 0 publications

High-Flow Nasal Cannula for Apneic Oxygenation in Obese Patients for Elective Surgery: A Systematic Review and Meta-Analysis

High-Flow Nasal Cannula for Apneic Oxygenation in Obese Patients for Elective Surgery: A Systematic Review and Meta-Analysis

A Comparison of Different Doses of Sufentanil Combined With Flurbiprofen Axetil In Postoperative Analgesia for Children Undergoing Innominate Osteotomy in China

Extra‐oral drainage of submandibular abscess under local anaesthetic: review of the literature and case series

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